1. Non-Therapeutic Circumcison (No medical indication) is ethical when the male himself is old enough, mature enough, and informed enough to give informed consent to the procedure. This is usually in adulthood when the male has reached a minimum of 18 years of age.

Informed consent should include knowledge of the following:

a. That it is a painful procedure.
b. That the foreskin is normal and healthy male anatomy, that has 20,000 pleasure nerves and anatomical structures that facilitate the mechanics and enjoyment of sex, and that these are all lost to circumcision.
c. That safe sex still needs to be practiced because circumcised men all over the world are infected with HIV, and STI's. Circumcision Countries like the USA have 33 times gonnoreah infections 19 times Chlamydia infections and 3 times HIV infections than Non-circumcision cultures like Holland that practice high levels of safe sex.
d. That the degree of medical benefit from circumcison when weighed against the costs and the alternative clinical and medical methods for achieiving these claimed benefits does not warrant circumcision. That alternate clinical, behavioural and medical methods can achieve superior outcomes than circumcision without the harms and losses.
e. That the greatest benefits from a non-therapeutic circumcision are psychological, in that a conscious decision has been made for one-self about one's body, and it is also psychologically related to consciously deciding for one self to belong to a socio-cultural group*.

2. Circumcision is ethical if it is medically therapuetic (which is very rare: Finland data 1 in 16,761 cases), ie. all conservative treatment methods have been considered, tried and failed or considered medically unsuitable, and circumcision is the last resort, and only way of providing therapy.

NB* Much confusion arises out of the Belonging to a Socio-Cultural group argument. Non-Therapeutic circumcision of minors may provide a psychological benefit to the adults, elders, parents, or authority figures within a socio-cultural group, but at the expense of the human rights violations of the individual child. The adults of that community could adjust their beliefs and declare that "all male children with a foreskin also belong to our socio-cultural group". So let us not confuse adult psychological needs with children's psychological needs. All a child needs is a sense and belief they are loved and wanted for who they are, foreskin and all.

Sunday, February 20, 2011

There are many reasons why the circumcision clinical trials will most probably not necessarily translate to real world effects.

1. The clinical trial effects are too low, a 50% clinical effect leads to low population level protection. French researcher Garenne, demonstrated that clinical effects do not always translate to Population effects (Major reason being size of clinical effect), and that past research had shown that vaccinations that had a 50% clinical effect had virtually zero population effects.

2. Men will adapt their behaviour to make up for circumcision. Whatever loss of sensation men experience, will be made up for in adaptation of behaviours and this could mean, more frequent sex, more vigorous sex, although speculative there could be more varied sex including the possibility of anal intercourse, more sex partners, less condom use, less safe sex behaviour.

3. The trials were ended early exagerrating clinical effects.

4. The real world wont have the same levels of clinical support, clinical efficacy, and education that the clinical trials had.

5. Relative risk reduction and episodic protection is not life long protection, or absolute risk protection.

6. Women appear to be infected at 50% higher rates when having sex with a circumcised man. This may be due to resuming sex too early before wound has healed, more vigourous sex or more frequent sex to compensate for loss of foreskin.

7. Trials demonstrated high internal reliability, but little evidence of external validity, which appears quite low when examining populations. Garenne found that certain populations of circumcised men have higher rates of HIV infections, than non-circumcised populations in certain African Nations.

8. There may now be a greater reliance of circumcison than wearing condoms and practising safe sex.

9. No emphasis was made on addressing the major cause of high population infection rates, namely high levels of promiscuity, high numbers of sex partners, and it is this cultural behavioiural phenomena which requires, massive culture change.

10. The trials were not double blinded the reserachers knew who were in the circumcised group, and the circumcised group received more attention, time, education, and emphasis on wearing condoms.

11. The USA which has the highest circumcision rates in the western world, and also the highest rates of HIV & STI's in the western world. Studies that examined the differences noted Americans tended to have a higher number of sex partners and used less condoms than their European peers. This may be that American men who are circumcised adapt their behaviours to compensate for lack of foreskin, or other factors may be contributing, such as cultural sexual practices. What it does demonstrate is that an increase in unsafe sex behaviours eliminates any protective effect that may be evident in a clinical trial setting.

Friday, February 18, 2011

When you have a Professor of Microbiology setting up a website (circinfo.net) which promotes male circumcision and is constantly in the media promoting circumcision, and even attacking the Royal Australasian College of Physicians for Refusing to Recommend infant male circumcision in Australia, it is important to ask whether this person has any credibility or authority in the area of circumcision. However, when arguing or debating a topic it is important to not rely on Ad Homminem personal attacks as your sole argument. I do believe that it is important to question someone's credibility when they claim expertise in an area, and particularly when this expertise is questionable. IN this case I do not believe questioning someone's credibility is an Ad Homminem attack. In the area of Molecular Biology Prof Brian Morris has legitimate qualifications and credibility, that is not in question here. What is in question however, is whether a Professor of Molecular Biology has any authority to speak on Infant Child Health, in particular circumcision.

I will argue that it is legitimate to attack Brian Morris credibility as an authority on circumcision and child health, because of the biased claims he makes in favour of infant circumcision, and the lack of qualifications he has to make these claims. Firstly, He is a professor of Molecular Biology and not a Pediatrician, nor a Medical Doctor, nor a Urologist. In Australia the leading authority on Child health matters is the Royal Australasian College of Physicians (RACP) and Prof Morris is not a member of the RACP. For more than 2 Decades now the RACP has recommended against routine infant male circumcision and that it is not required in an Australain context. Yet Brian Morris an Academic from the University of Sydney who's specialty is Molecular Biology continues to recommend routine infant circumcision, in spite of the RACP's recommendations against it. I would argue that he is neither a practitioner nor expert in the area of male genital health or child infant health, and therefore he is unqualified to make recommendations on infant male circumcision.

Historically, and well documented, Prof Morris's behaviour has been found to be totally in favor of circumcision and against anything that is anti-circumcision, and therefore I would argue he is not impartial. Info below.

Most recently Morris was called a bully in response to a peer review journal criticism. The reseach by Morten Frisk found circumcision harmful to both male & female sexuality and Morris tried to have this research banned from publication, and used bullying tactics to try and achieve this. http://www.circinfo.org/Circumcision_and_sexual_function.html

Also Recently, Brian Morris, & colleagues Cooper & Wodek were found to have Mis-represented the circumcision rates in Australia, claiming in the Australian Medical Journal that current circumcision rates had reached 19% for Australia, when in fact Medicare statistics show current circumcision rates have never exceeded 13% for the whole of Australia. The 19% figure comes from one state of Australia (NSW), how do 3 highly intelligent men make such a basic error of reporting? Makes one wonder when the obsession for infant circumcision is so strong, that maybe perceptions are skewed??? Below is a critique found on the Circumcstitions website, well worth a read, highlights mutiple episodes of mis-representation for a man (a biochemist) who is not a pediatrician or urologist or medical doctor yet claims expertise in circumcision?

Again, recently in the Medical journal of Australia 8 letters were received which strongly criticised the proposal by Cooper, Morris, & Wodek that infant circumcision was akin to a surgical vaccine for HIV : http://www.circinfo.org/MJA_Cooper_letters.html
http://www.circinfo.org/MJA_Cooper_letters.html

“I have some wonderful photographs of a group of Masai boys in their early teens that I met in Kenya in 1989 dressed in their dark circumcision robes, with white feathers as headwear, and white painted facial decoration that stood out against their very black skin.

Each wore a pendant that was the razor blade used for their own circumcision. The ceremony that they had gone through is a special part of their tribal culture and was very important to these boys, who were proud to show that they were now ‘men’. In other cultures it is associated with preparation for marriage and as a sign of entry into manhood.”

And his site links to proven circumfetish sites (and vice-versa).. and the usual testimonials present in all fetishist sites.

Reviews of his book which contains info from his site–including one from the Jam and from some of his fellow Austs..

Brian Morris is a professor of Molecular Biology and hypertension-field of study at the Univ Of Sidney, Aust HE is NOT a MD nor a circumcision expert.

The Journal of Australian Medicine (1999, vol.11, no.11, p.18), which has no apparent interest in either defending or condemning circumcision, has reviewed Dr. Morris’ book and given it a thumbs down. Here’s an excerpt from that very sensible review:

“In those with a normal bladder and kidneys the argument for circumcision may be akin to suggesting prophylactic removal of the tonsils or the appendix; the latter are obviously as silly as taking seriously any study supposedly concluding that either version of the penis ‘looks better’.

Also, is the author really serious in suggesting that routine circumcision is needed to prevent zipper injury? Unfortunately, once again, a presentation on the subject of circumcision has not advanced the development of a scientific approach.”

Reviewer: A reader from Bond University Men’s Health Research Center, Gold Coast, Queensland, Australia September 2, 1999 This book was reviewed (above) in “glowing terms” by a physician, who openly admits to having circumcised a large number of unconsenting minors (who happen to be boys). Consequently, he has a vested interest in promoting genital reduction surgery (erogenous foreskin amputation). Are physicians now to take their medical advice from obsessive genital cutters, rather than from recognized professional bodies? Not one national medical association anywhere in the world recommends unnecessary circumcision!

This book selectively cites outdated studies many of which have been thoroughly discredited in the scientific medical literature for decades. For example, this book states that penile cancer is reduced by circumcision. Nothing could be further from the truth.

Representatives of the American Cancer Society (Feb 16, 1996) stated that infant circumcision is not a valid or effective measure to prevent penile cancer which affects only one in 100,000 males.

The Australasian Association of Paediatric Surgeons stated (April, 1996) that “neonatal circumcision has no medical indication.”

The Queensland Law Reform Commission (Dec, 1993) stated that “routine circumcision could be regarded as a criminal act.”

The primary dictum of ethical medical practice is “First do no harm.” Yet there is now overwhelming evidence that infant circumcision causes irreparable harm physically, sexually, and psychologically.

Much of the life-long harm caused by imposed genital cutting (on unconsenting minors) is documented in the British Journal of Urology, 1999 (Vol 83, Supplement 1). Also see website: http://www.cirp.org/ <http://www.cirp.org/> listed by the British Medical Association.

Gregory J. Boyle, Ph.D Professor of Psychology and Director, Men’s Health Research Centre Bond University, Gold Coast 4229 Australia BOOK LACKS SCIENTIFIC EVIDENCE AUSTRALIAN MEDICINE, 1999, Vol. 11 (No. 11), p. 18. by Professor Paddy Dewan Extract — “….[The author] understates the nature of the procedure, omits several potential complications and downplays the importance of circumcision to the income of American doctors. Also, Dr Morris omits to mention the medical treatment of phimosis, and he overstates the adverse events associated with phimosis when he states that “as a result of phimosis, males will be unable to urinate. The bladder fills up and urinary retention becomes a painful, alarming and dangerous experience”. This is a marked variance to the many boys who usually present with minimal symptoms with phimosis, which is easily treated by the application of steroid cream for four to six weeks.

“The increased risk of urinary tract infection in uncircumcised boys is probably real, but it remains arguable if the data used to support circumcision is analysed more critically. Even so, circumcision for boys with renal anomalies, that is, those having intermittent catheterisation or with immune deficiencies, is probably appropriate–these arguments are not presented in Dr Morris’ book. In those with a normal bladder and kidneys the argument for circumcision may be akin to suggesting prophylactic removal of the tonsils or the appendix; the latter are obviously as silly as taking seriously any study supposedly concluding that either version of the penis “looks better”. Also, is the author really serious in suggesting that routine circumcision is needed to prevent zipper injury?

Furthermore, he chooses to select penile cancer figures that support his argument, then proceeds to accuse the anti-circumcision group, NOCIRC, of “distortions, anecdotes and testimonials”, and Dr. Paul Fleiss of “off the wall statements” to support his case to keep the foreskin. Dr Morris then concludes, “if anything, circumcision by freeing the penis of the encumbrance of a foreskin can only serve to enhance penis size”.

“In quoting a Forum magazine study, referring to the opinion of a “Seinfeld” character and stating that “the uncircumcised man may need several showers per day”, further undermines Dr Morris’ efforts to have us take seriously the data otherwise collected. Unfortunately, once again, a presentation on the subject of circumcision has not advanced the development of a scientific approach….”

Professor Paddy Dewan is a Paediatric Urologist from the Royal Children’s Hospital, Melbourne.

Dr. James Powell from Chicago, Illinois , October 28, 1999 A book without emotions…..or FACTS! I find it totally ridiculous that such a book exists in which the author makes his claims on completely anecdotal grounds. There are few facts presented in this book. You will not find the information you need to educate yourself about this topic in this book. If you want GOOD information from people that know what they are talking about, refer to the vast multitude of anti-circumcision facts that are on the internet, or the vast amount of more factual books available. And please avoid Mr. Morris’s own website as you will find nothing but the same delusions on it as in his book.

Dr Morris recently wrote a letter to the Medical Journal of Australia to promote circumcision.

“The letter by Morris is more difficult to discuss as it relates, on the whole, to the use of routine circumcision, which was not the focus of our article. The issues raised by Morris seem to be at complete odds with the 2002 Policy Statement on Circumcision by the RACP — which is also consistent with the recommendations of the Canadian Paediatric Society and the American Academy of Paediatrics.4 The RACP Policy Statement reviewed most of the points raised by Morris, including urinary tract infections, STDs, human papillomavirus and carcinomas of the cervix and penis. In each case, after an extensive review of the literature, the RACP reaffirmed that there is no medical indication for routine circumcision. Morris’s view on the reduction of risk of sexual problems is at odds with the article by Darby,9 published in the same issue of the Journal as our article, and is beyond the scope of our study. His claim that circumcision improves appearance is highly subjective and unsubstantiated, and should not be used to justify the surgical removal of tissue that may have a benefit to the individual later in life”

His deceits:

Dr. Brian J. Morris, Ph.D. is a biochemist at the University of Sydney.

He has written a very pro-circumcision page on the Internet.

His page is full of errors. He frequently misrepresents his sources. Many of his sources are on the CIRP so one should go there and read them to see what they really say.

For example, Dr. Morris writes”

“In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996 [6]. In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised.”

In reality, the Australian College of Paediatrics states:

“The College believes informed discussion with parents regarding the possible health benefits of routine male circumcision and the risks associated with the operation are essential. Up-to-date, unbiased written material summarising the evidence in plain English should be widely available to parents.”

The essay “Medical Benefits From Circumcision” by Brian Morris is a case study in misinformation! For example … Morris – “In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996. In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised.”

Australian College of Paediatrics – “The College believes informed discussion with parents regarding the possible health benefits of routine male circumcision and the risks associated with the operation are essential.”

Morris says that the ACP urged that parents be fully informed of the benefits, but he totally ignores their recommendation that parents also be fully informed of the risks.

Morris – “Similar recommendations were made recently by the Canadian Paediatric Society who also conducted an evaluation of the literature, although concluded that the benefits and harms were very evenly balanced.”

Canadian Paediatric Society – “The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed.”

In 1982 the CPS took a position against routine infant circumcision because “there are no valid medical indications for circumcision in the neonatal period.” The CPS did not change their position against RIC in 1996. Morris conveniently ignores the Canadian Paediatric Society’s opposition to routine infant circumcision.

Morris – “The American College of Pediatrics has moved far closer to an advocacy position …”

The Department of Pediatrics at Johns Hopkins University has a web page that lists many pediatric organization. There is no organization called the “American College of Pediatrics”. The following are among the many organizations they list – American Academy of Pediatrics, American Pediatric Society, and American Pediatric Surgery Association.

Also “American College of Pediatrics” is not listed in online phone directories.

Morris has probably confused the American College of Pediatrics with the American Academy of Pediatrics. Assuming that is what he did, let’s look at the statement, “The American Academy of Pediatrics has moved far closer to an advocacy position …”

The American Academy of Pediatrics (AAP) issued statements on routine infant circumcision in 1971, 1975, 1983, and 1989.

AAP (1971) – “there are no valid medical indications for circumcision in the neonatal period.”

AAP (1975) – “there is no absolute medical indication for routine circumcision of the newborn.”

The AAP reiterated their 1975 position again in 1983.

AAP (1989) – “Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.”

While it may be “technically” correct to say that the AAP has “moved closer to” an advocacy position, the statement by Morris is misleading because the AAP has *not* taken an advocacy position in favor of routine infant circumcision. A more correct statement would be, “The American Academy of Pediatrics has softened its opposition to routine intact circumcision.” Softening one’s opposition to a policy is not the same thing as advocating that policy.

Later in the article Morris again misrepresents the position of the American Academy of Pediatrics (AAP).

Morris – “The trend not to circumcise started in the mid to late 1970s, after the American Academy of Paediatrics Committee for the Newborn stated, in 1971, that there are ‘no valid medical indications for circumcision’. In 1975 this was modified to ‘no absolute valid … ‘, which remained in the 1983 statement, but in 1989 it changed significantly to ‘New evidence has suggested possible medical benefits …’”

The sentence that Morris quotes from the 1989 AAP report is in the introduction, not the conclusion. The conclusion of the report states clearly that there are both potential medical benefits and risks. Morris does not mention the disadvantages and risk of infant circumcision. He leaves the impression that the AAP only mentions benefits.

AAP – “Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.”

“The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.”

“We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.”

“Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove.”

AMA (Aust):

The AMA will discourage circumcision of baby boys in line with the Australian College of Paediatrics’ Position Statement on Routine Circumcision of Normal Male Infants and Boys.

The statement, released in June and supported by the AMA’s November Federal Council meeting, includes: The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.

Now if you think this man has any credibility as an unbiased objective commentator on infant circumcision–you need to think again.

About Me

Mid 50's Medical professional multiple interests and various post-grad quals, worked in a variety of settings, from Hospitals, Govt health and Welfare depts, Universities, TAFE Colleges,Community Clinics, Private clinics, Now Self-Employed in private consultancy, but do part-time work in public hospitals. Have lectured post-grad students in Statistics & Research methods and am apalled at scientific illiteracy of the medical profession.